Your Questions
Your Questions
Q: Dr. Eppley, how much can be done with aesthetic iliac crest reduction? is it possible to improve the “v taper” look in a bodybuilder with this procedure? is it actually noticeable as a result or are results negligible? how bad is scarring?
A: I do not think this procedure can remove enough to create the V taper like in body builders.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for Testicle Enlargement Enhancement procedure. I have had atrophy shrinkage of the Testicle due to Testosterone treatment. I am looking for the procedure where you encase the existing testicle. I am in excellent health. What is the cost ? How many of these procedures have you done? This is done as an outpatient procedure correct?
A: Thank you for your inquiry. There are advantages and disadvantages to the testicular implant encasement technique. My experience is that it is only a good technique if the existing testicles are at least 3.5cms or bigger. The risk of slippage out of the implant is much higher the smaller the testicles become. With testicle implants in size they would dwarf testicles 3.5cms or smaller and have no risk of displacement. (side by side technique)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, For a forehead reduction surgery in a young male with no hair loss, what kind of incision do you use? A hairline incision or coronal incision?
A: For male forehead reduction the use of a frontal hairline, immediate retrohairline or semi-coronal incision can be debated and all of them can be used. Each one has their advantages and disadvantages. It also depends on what type of forehead reduction is needed. Without knowing the type of forehead reduction it is impossible to determine which of these incisional approaches may be best.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a vertically short undefined jawline and flat cheeks. I was interested in a sliding genioplasty, I’m more interested in vertical lengthening than projection, and maybe submental lipo. My chin is short and points upward and makes my face and neck seem wider than I’d like. I attached some pictures, the first 7 are what my jawline looks like now and the last 3 are edited to show what I was hoping to achieve.
A: Thank you for your inquiry and sending your pictures and imaging. You have demonstrated a pure vertical chin lengthening procedure that is probably at 8mms vertical increase. As you have demonstrated this corrects the upward chin tilt and creates a smoother longer jawline. (mandibular plane angle) That chin bone change and some submental liposuction would be a good combination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi…I’m in the beginning stages of exploring breast augmentation surgery. I’m 59 and have never been satisfied with the size nor shape of my breasts. I’ve decided that at my age and stage of life, why not? Any information you can send would be greatly appreciated. Thank you.
A: Thank you for your inquiry. When it comes to breast implants at any age the relevant questions are:
1) Does breast sagging/ptosis exist? (Is a breast lift needed with implants)
2) What type of breast implants does one want? (saline vs silicone)
3) What size of breast implant does one want? (in terms of volume in ccs, that usually requires preoperative volumetric sizing)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m looking to have a procedure done but I don’t know how any of this works I’m 28 male 360lbs have buried penis was wanting to see how they would want to go about it how much weight they would want me to lose before I had surgery etc
A: I do not operate on any patients over 300lbs for medical reasons. Your buried penis surgery outcome would also be much improved if you lost 60, 80 or 100 lbs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Regarding the surgery itself, if there are any current asymmetries in my chin, can they be corrected with this surgery, or would that require an implant?
⁃ Can any width be added to the chin with this surgery, or would that too require an implant?
⁃ Lastly, one of my main objectives is to fill/flatten the labiomental fold as much as possible, so I just want to make sure our current plan is going to achieve this. I’ve read that a bone graft is often used to fill in the fold, but I’m not sure if this would be a separate graft from the one we’ll already be using to achieve the vertical lengthening and lateral projection, or if the same graft will achieve all of the above.
A: In answer to your chin reshaping questions:
1) I am not sure what chin asymmetries they are as I can’t see them but any improvement in them from a vertical lengthening bony genioplasty would be a bonus not an expectation from the procedure.
2) While chin widths can be added to certain bony genioplasties (midline split and graft), I would be cautious about doing that to a vertical lengthening genioplasty due to the risks of instability and devascularization of the bone. That can either be done by adding on a implant at the time of the bony genioplasty or have it done secondarily.
3) By definition when you pull down on the chin (vertical lengthening) the labiomental creases unfolds and becomes less deep due to the stretch of the soft tissue chin pad. The bone graft fills the bony gap created by the vertical lengthening, it does not directly augment or push out the labiomental fold.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would it be possible to do a three in one procedure that reduces the width of the temples, reduces the frontal bossing of the forward that results in excess convexity, and lower the hairline at the same time?
Simply put I think my forehead is too tall, wide and convex.
A: You are correct in that frontal bossing reduction , reduction of the bony temporal line and a hairline advancement can all be done at the same time. The frontal hairline incision provides convenient access to do the bone reduction procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello sorry I forgot to send you a pre surgery photo of my chin reduction surgery. This is how it was before I am so upset with how it looks now I would do anything to try and make it look as better as it use to be.
A: Thank you for sending your before and after chin reduction pictures. You did not say how your chin reduction was done but the combination of a wider/flatter chin shape and the chin pad irregularities/dimpling would indicate to me that anterior chin shave was done, most likely from an intraoral approach. With the soft tissues stripped off of the bone and the bone support of the chin reduced, the soft tissue chin pad has limited ability to shrink back down around the shorter bone. Instead it often ends up into a contracted ball of muscle and skin which is why it looks irregular.
The best course of action is to add back some bone support (implant or a sliding genioplasty and release and redrape the soft tissues over a restored bone support. I would lead towards the sliding genioplasty because this can move the bone forward as well as shorten it at the same time which is beneficial aesthetically as well as for the best soft tissue support.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had custom MEDPOR jaw implants four years ago and I would like to have them removed. I plan to have a revision orthognatic surgery to correct facial imbalance but the surgeon won’t do the surgery unless the MEDPOR implant is removed first. And you know most surgeons don’t like to remove medpor implants.
I would like to know if would be feasible to remove those implants. Also, I would like to know if they can be totally removed (I read about some patients not having the entire implant removed by their surgeon). I have attached pics of the implants.
Thank you for your attention.
A: Thank you for your inquiry and sending your jaw angle implant design pictures. Whether they are actually placed as they look in the design file is not known and there is no way to find out since the Medpor material can not be seen on a 3D CT scan. Regardless they can be removed and it has not been my experience, which is extensive with their removals, that they can not be removed in their entirety in a single surgery. This does not mean it is easy or non-traumatic to the soft tissues but it can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi I have flat head syndrome, my head bulges wide on the sides kind of points up on a cone and is pretty flat in the back. I’m 25 years old and have been self conscious about this since I was a child. I am wondering what procedures can be done.
A: I believe when you say ‘flat head syndrome’ you are referring to a flat back of the head. When the back of the head is flat the posterior parieto-temporal regions get wider and often the crown of the skull is higher…just as you have described in your own situation. The most effective strategy with minimal scarring is a custom skull implant to build out the back of the head.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I did gynecomastia reduction surgery five years ago. Recently did a nipple reduction. Post nipple reduction scar tissue developed around nipples and areolas. I visited previous doctor 4x for the steroid shot. He is now advising me that I will have to do a revision to remove scar tissue. I don’t trust the doctor and want my areolar flat. Please advise and See pics of nipple erect. This drives me crazy and I need this fixed asap
A: There are only two reasons why an areola remains ‘puffy’ after open gynecomastia surgery. First there may be residual hard breast tissue that remains. (most common reason). Second, scar issue has formed. Either way and given that it has been over five years after the original surgery a secondary open areolar excision is needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my areolar were not puffy right after gynecomastia reduction surgery, but I did notice my areolas did shrink and my nipples seemed to be a lot bigger than normal. So I had a nipple reduction and then after the nipple reduction I noticed irregularities around the areola where it’s not flat. What would be the procedure to get this fixed? My plastic surgeon is telling me to open the areola again to remove scar tissue. What method will you use? How do I ensure that my areolar will be flat and it won’t look awful when nipple and areola is erect. It looks okay when it’s not hard but when my nipples are hard the areolar and nipples are shriveled into one. How would you fix this?
A: What the areola looks like right after surgery is very deceiving as the swelling can make it look flat, only to appear puffy months later. It is an artistic judgment as to how much breast tissue to remove in an open areolar excision and most surgeons are understandably going to err on the more conservative side to avoid the dreaded crater deformity. Thus when it occurs further tissue reduction is needed through an open areolar approach.
Any type of gynecomastia surgery is done in the static situation not a dynamic one (i.e., the patient is laying flat and the nipple-areolar complex is non-erect.) No surgeon can completely predict what the effects of a static surgery are in a dynamic setting. But it is fair to predict that it will be better when more tissue is removed secondarily.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi – I am very bothered by my asymmetric chin and have been unsuccessful in identifying the best solution for this. I was initially advised a chin implant but think I have too much on the longer side and am scared to add more.
A: You are correct in that subtraction is the best approach to your chin asymmetry not addition. (see attached) This is best done through a submental approach where the inferior border of the chin can be reduced.
In reality your chin asymmetry is not just localized to the chin, it extends much further back along the jawline as well. Ideally a 3D CT scan would be beneficial for preoperative planning to both measure how much bone should be removed as well as to how far back the resection should extend.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I was wondering if I would be a good candidate for fat injections under the eyes. I have attached pictures of my problem areas.
Since I was a teenager I have always felt insecure about my dark circles. It doesn’t matter how much sleep I get, whether I exercise, or eat healthy. My dark circles never go away.
I’ve heard of Juvederm and Restylane, but I was wondering if fat injections are better and if they last longer.
A: Your congenital dark circles are indicative of an infraorbital rim deficiency. As a result the puffiness you see is pseudo fat herniation. There are a wide variety of approaches to treating what you have, most of which involve adding volume. (synthetic fillers, fat injections, dermal fat grafts, alloderm grafts and various type of implants) There is also a technique of fat grafting known as fat transposition where the herniated fat is moved into the tear trough area.
The wide variety of treatment options speaks to the differing opinions about how to treat it. You can fundamentally break all of these procedures into two categories, non-surgical and surgical. Most people will try a non-surgical method first because it is non-surgical and it can be a test to determine if adding volume would be an effective approach. I would stay away from injection fat grafting as the first procedure because it is a surgery, irregularities are common and such irregularities are difficult to treat. Synthetic fillers are a safer initial volume approach because the use of hyaluron-based fillers are completely resorbable/reversible.
If one graduates to surgery orbital fat transposition or alloderm grafts are a more natural approach that always produce positive results although complete elimination of them is not assured.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know if upper eye lid surgery and rhinoplasty can be done in this same visitation. As I would like to minimize my down time with one visit.
* what will be the pricing for eye lid and rhinoplasty combined. If able to.
Or separate.
* do you have any photos I can refer to for noses such as my type?
* I would like to achieve a smaller narrow nose with a bridge.
Thank you.
A: You can do an upper blepharoplasty and rhinoplasty during the same surgery.
I would refer you to one of my websites, www.eppleyplasticsurgery.com and search under the rhinoplasty photo gallery. I would also refer you to another of my websites, www.exploreplasticsurgery.com and place in the search box on the home page the term, augmentation rhinoplasty, where you can look at the case studies.
While looking at other patient results has its merits what really matters is what type of changes can be done in your nose. This is where the role of computer imaging has value. To do so I will need a side and oblique view picture which, when combined with the front view picture you have already sent, will allow this rhinoplasty predictive imaging to be done. This is especially important in your nose because there are significant limitations in how of a smaller more nose shape can be achieved in the thick-skinned nose with a congenital lack of framework support
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my question is regarding the clavicle lengthening surgery! I’ve heard that in order to widen the whole shoulder frame it is not possible doing it just through clavicle lengthening, the scapula needs to be lengthened as well, but scapula surgery is not possible since it is fully wrapped in muscles. I’d be glad to hear your comment on this issue.
A: My only comment is that as the clavicle is lengthened the bideltoid distance equally increases, thus widening the shoulders. In the range of how much clavicle lengthening can be done there is no need for a change in scapular width to achieve that effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am self-conscious about my mid face. My cheekbone is large and projects outwards but the area below that (my nasal base area, I believe it’s called the paranasal area) looks sunken, giving a concave side profile in this specific area. I also feel like I have a mild case of bimaxiliary protrusion, which I think is accentuating the sunken paranasal area. I have attached my selfies and also two ideal before and after pictures.
A: Thank you for your inquiry and sending your pictures. You have the classic combination of a wider face that lacks central projection. The ideal image result you are showing in not just paranasal augmentation but a combined premaxillary-paranasal augmentation. The debate about such premaxillary-paranasal augmentation is whether that should be done using implants (ePTFE premaxillary and paranasal implants or using the patient’s own cartilage. (rib cartilage) That is a personal choice of the patient’s.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m currently considering forehead augmentation surgery to make my forehead less sloped, more symmetrical on each side and more prominent at the front. I wanted to ask whether adding additional PEEK material or bone cement will automatically change the top of my head shape slightly, as this is connected to my forehead. I also ask this because I had previous surgery where the forehead bone was shaved down very thinly and in the process my frontal skull/head connected to this forehead area also became very flat at the top and front. Please note that the top of my head was not touched in the previous surgery, only the forehead bone was shaved down. I noticed that in the picture below, the top of the patients head also changed shape slightly and appears higher and less flat (like the forehead) after forehead augmentation surgery. Could you please advise me on the cost of the same procedure or by using peek implants instead?
A: Like all forehead augmentations, it can not just stop at the top of the forehead unless the forehead augmentation is but a millimeter or two. As the slope of the forehead becomes less the implant design must extend further back onto the top of the skull and over the sides of the bony temporal line onto the temporal fascia to blend into the rest of the skull. (see attached)
Because of the need for these extensions and that they be smooth and very feathered, the use of bone cements has largely been abandoned. This requires a computer designed implant. Unless one wants a full coronal scalp incision to place the implant this is also why PEEK and any other completely inflexible materials are also not desired by most patients today. Solid silicone skull implants offer the far superior method for any form of aesthetic skull augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 24 years old, I have grade 3 hair loss. There is a high probability that I will have to be bald for the rest of my days. And I don’t even mind, the only thing holding me back from this is my head shape. I have bulges on the back of my head and the most offensive is something like a sharp springboard from above, on the site I saw a lot of photos with a similar situation.
And I am very interested in aesthetic skull correction surgery. I have a couple of questions
1. Will it stay forever? As far as I know, the skull changes throughout life, can this somehow affect the implant?
2. I understand that scars remain after the procedure, but how visible and large will they be? This is very important since I will be bald
A: As best as I can gather from your pictures and description you have a classic occipital knob protrusion on the back of your head. That can be completely reduced and smoothed through a very small scalp incision over it. Such a skull reduction is permanent.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, i´m a middle aged female, I had cheek and chin implants done about 20 years ago.The chin implant was redone about 10 years ago, for the reason that i suddenly had strange tightness that was pulling at my lower lip if i remember , original was a button implant, it looked completely natural and new surgeon didn’t believe i had an implant , i think i have an anatomical wing implant now , ive never been happy with this one, i can feel the edges under my jaw and it disturbs me, i’ve also recently been aware of it more for example pain when i open my mouth wide for dental check ups , and in my sleep if there is any pressure to it.
The cheeks are not aging so well , i think there is some south migration of the right implant, they were not fixed with screws. i´m really a bit stressed about it all. i wish i had my original face back no implants , but i don’t think my face is not going to look normal without them at this point. ..so i would like it all redone, customized this time, that was not an option back in the day when i had them.
if you could tell me roughly how much this would be , how or if its possible to customize new implants with implants there already. ? any info would be really appreciated. thank you for your time, i look forward to hearing from you
A: Thank you for your inquiry and detailing your facial implant history. Undoubtably the longer wings of your chin implant are the source of your symptoms and dissatisfaction as they can be for some women. Not only do the longer wings create a chin that looks wider but can also be a source of symptoms if the implant has asymmetry or if the implant is positioned too low. As for your cheek implants besides the asymmetry I suspect not aging well means that there may be implant show where the implant become more visible and looks unnatural.
Custom cheek and chin implant can be done and are designed off of a 3D CT scan in which your indwelling implants can be seen, digitally removed and new ones designed as their replacements.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a theoretical question about a subcostal rib cage implant for one side of my body. I was born with underdeveloped and thinner ribs on one side of my body (a rare variation of poland syndrome). IT is not from anything, they are actually thinner on my right side as my chest too with even strength on both sides is very unequal in thickness no matter what I do. I could get rib shaving on the other thicker rib cage to even it out, but the problem is my hips are too bulky for that. Because of this underdeveloped rib cage, my right side abs don’t really go out in front of the hip or level making the hip look really bad and buldgy and my abs aren’t at the same level which looks really off. ISS there any implant (Im assuming a rib one) that could be made that would push those right rectus abdominal muscles a bit further out to match the other side? Also this unevenness in my rib cage is also present in my chest thickness (Going to have an implant in my right chest to help feel straighter because I always feel crooked) but could the same thing be done with the rib cage below the chest? I can’t find a good picture that depicts the uneven level of the abs but it is very apparent visually.
A: Thank you for your inquiry and detailing your body contouring needs. What you have described is very possible because the subcostal rib cage is largely covered by the upper portion of the rectus abdomins muscle. This provides the opportunity to place an implant on top of the ribs but under the muscle which would do, just as you have described, push out the right rectus abdominus muscle. Not only would this create that effect but also places the implant in the most favorable location. (submuscular location)
Whether the same concept applies to higher up on the chest requires a better understanding of the actual chest wall deformity as well as where that is location compared to the pectoralis major muscle attachments.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m very interested in hip implants. Is after hip implants is a bbl possible. But I want also transfer the bbl fat in my hips. Is this possible too? Or should I make first the bbl? Is the doctor also doing bbl? If yes, is it possible make a bbl when I have butt implants? Or did the doctor need them take out?
A: In answer to your hip and buttock implant questions:
1) A good candidate for successful hip implants is based on two criteria: 1) adequate subcutaneous tissue thickness over the hip area (which you have) and 2) moderate but not extreme hip augmentation goals. (which in you I do not yet know)
2) Fat transfer to the hips should always be done first, if one has adequate fat stores to do so, before undergoing hip implants.
3) Fat transfer (aka BBL) can be done with intramusculr buttock implants and is known as composite buttock augmentation surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you reduce a high spot the skull to make it level with rest?
A: That would depend on the thickness of the bone and how much it will permit the high spot to be lowered. How they applies to you requires a picture of the high spot at a minimum and ideally a 2D skull CT scan to measure the thickness of the bone at the high spot.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had coup de Sabre since I have been in 5th grade (10 years old ) mainly affecting my forehead and part of my scalp. I have been looking for doctors that are willing to do cosmetic surgery on my forehead to bring it back to its normal state but none have been willing. I have had consultations about this disease but never had answers. I came across this article of your procedure on a patient with my same condition and would love to have this procedure done to make me feel better and more confident with my look. Coup de Sabre has affected me in many ways. I hope to speak soon. Thank you for your time.
A: Thank you for your inquiry and sending your picture. I have treated numerous cases of linear craniofacial scleroderma, most of which have affected the forehead and scalp along the distribution of the supraorbital nerve. In treating the forehead contour deformity the brow and forehead bone is deficient as well as the overlying skin is thin. I have treated it with both bone cements and fat grafting and each has their own advantages and disadvantages. In the end the problem is both a combination of bone and soft tissues so ideally both are eventually needed for optimal results.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I read your website about waist narrowing/ribs removal surgery, and would like some more info. I have had a lot of surgeries so far, including 3 breast implant surgeries to take me to my current size of 2200cc. Also have butt implants and bbl, and want the extreme hourglass figure. I am totally into the fake plastic barbie look, and want to go all the way with this.
I’m quite small build, and the breasts is taking up much of my ribcage. Is having xl breast implants something that influences ribs removal surgery? I am going to get another redo on the breasts later this year to go bigger.
Attaching some pics of myself. Do you think I’m a good candidate for ribs removal surgery?
A: You are a good candidate for rib removal waistline narrowing surgery for two reasons:
1) In the spirit of making the maximal effort for the extreme hourglass look, you have addressed the breasts and buttocks above and below the waistline but have not yet done the waistline itself. So the third member of what contributes to the hourglass shape remains unchanged.
2) Women with the thinnest builds actually get the best waistline narrowing results because the fixed anatomy of the ribs is making the greatest contribution to its shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, To indicate the type of cheek changes I am looking to make I can only really represent those changes using photos other people that have the features. Essentially, I want to be able to have an ogee curve with the high angular cheekbone look directly underneath the eye which is associated more to a masculine 3/4 profile as well as hollow cheeks that contour as a result? I’m unsure about my facial structure generally and with where it currently stands, are my cheekbones already high but projecting more laterally? is it just that they are not anterior projecting enough therefore cannot replicate the look I’m referring to? What would you advise I do next?
A: You are fundamentally talking about some version of the high cheekbone implant which is designed to create that type of ogee curve change. (see attached) Whether that would have that effect in your face depends on what your face looks like which remains unknown to me at this point.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m currently considering forehead augmentation surgery to make my forehead less sloped, more symmetrical on each side and more prominent at the front. I wanted to ask whether adding additional PEEK material or bone cement will automatically change the top of my head shape slightly, as this is connected to my forehead. I also ask this because I had previous surgery where the forehead bone was shaved down very thinly and in the process my frontal skull/head connected to this forehead area also became very flat at the top and front. Please note that the top of my head was not touched in the previous surgery, only the forehead bone was shaved down. I noticed that in the picture below, the top of the patients head also changed shape slightly and appears higher and less flat (like the forehead) after forehead augmentation surgery. Could you please advise me on the cost of the same procedure or by using peek implants instead?
A: Like all forehead augmentations, it can not just stop at the top of the forehead unless the forehead augmentation is but a millimeter or two. As the slope of the forehead becomes less the implant design must extend further back onto the top of the skull and over the sides of the bony temporal line onto the temporal fascia to blend into the rest of the skull. (see attached)
Because of the need for these extensions and that they be smooth and very feathered, the use of bone cements has largely been abandoned. This requires a computer designed implant. Unless one wants a full coronal scalp incision to place the implant this is also why PEEK and any other completely inflexible materials are also not desired by most patients today. Solid silicone skull implants offer the far superior method for any form of aesthetic skull augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a full-chin-wing procedure about 1.5 years ago. The chin was forwarded by 4mm, giving me a harmonious side-view. However, the front view is unpleasant, since the jaw angles were blunted, leaving me with a U-shaped jaw line.
I am very interested in reversing this procedure. I have heard from several sources that it should be possible to reverse the changes made, by doing a revision chin-wing. I would like to hear your opinion about this.
As far as I have understood, the implanted hip-graft, which will be full fused with the bone by now, shall be removed. Thus making it possible to establish the old jaw position.
Is it possible to precisely remove the fully fused hip-graft, in order to reverse the changes caused by the first procedure.
I would very much appreciate your opinion on this matter.
A: Like all chin wing procedures it is a chin-anterior jawline procedure which has no effect on the jaw angle area. It can not improve the jaw angle length or width. Often it can even make the jaw angle look worse by comparison.
I see no reason that the chin wing osteotomy could not be recut and returned to its original position. Where the hip graft is located along the jawline is unknown to me but it has undoubtably healed and integrated into the surrounding bone at this point. Whether it can or needs to be removed in this chin wing reversal I could not say based on a description alone. You would need a 3D CT scan of your lower jaw anyway prior to the procedure and the location of the hip graft and its fate would then be able to be determined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in surgery to help fix my facial / cranial appearance and to help me feel like i can easily have a good neck posture. I have a weak chin, jaw, and cheek bones. My orthodontist agreed with me and has x-rays but said she couldn’t do anything to help. In addition i feel like my head is misbalanced in that most of my weight is the back. I did not have the benefit of positive horizontal facial cranial growth forward. For years i’ve felt awkward trying to have a natural neck position. When I try to have a natural neck position most of my face looks squished and most of my head is balanced in the back making it difficult to keep this position. In addition to trying to keep my natural neck position it is hard to talk. Maybe i’m over correcting my posture at that point but it’s hard to know without a medical profession correcting me with what is actually natural. Over the years my neck posture has gotten worse and have neck pain because i’m trying to look “normal” without my face looking squished and my natural propensity to keep my head slightly forward so i can talk correctly. Keeping my head forward from a natural neck position isn’t very comfortable on the neck.
The follow pictures will show my side profile and front profile. I would like the doctor’s opinion on my comments and my pictures. Is there anything that could be done? At the very least I would like to improve my neck posture and have a “normal” side profile.
A: Thank you for your inquiry and sending your pictures. While there are procedures to help with your jaw deficiency (custom jawline implant) and protrusion of the back of your head (occipital skull reduction) which will have aesthetic benefits (see attached imaging) I would not expect that to change how you hold your head. (neck posture) Neck posture is a learned behavior. It is possible that you hold your head that way because of your short chin/jawline and these aesthetic improvement may help, but any improvement in your neck posture should be perceived as an unexpected bonus and not an expected outcome from these surgeries.
Dr. Barry Eppley
Indianapolis, Indiana
